Art Caplan: "Little Hope of Medical Futility"

In the November 2012 issue of the Mayo Clinic Proceedings, Art Caplan finds that "the future of futility assessment, as well as downstream actions based on those assessments, looks bleak."  



"Battling to get recognition for futility policies does not hold much promise of resolving the hardest battles at the bedside.  Improving how we communicate about course of care does."  Caplan rightly urges that our energies are better focused on improving clinician-patient communication.  



But even with improved end-of-life communication there will still be intractable conflict.  Maybe in only 5% of the disputes.  But it will remain.  Should clinicians just cave-in to surrogate demands for continued life-sustaining treatment in all these cases?  Notwithstanding the resulting moral distress?  Notwithstanding clinicians' professional integrity?  Notwithstanding their conscience-based objections?  Notwithstanding the risks imposed on other patients turned away from a full ICU?  



Many think that the answer to these questions is, at least sometimes, "no."  Therefore, it is worth developing fair and transparent dispute resolution mechanisms.  Art Caplan is right to observe that the law has not been moving quickly to support such mechanisms.  But neither has the law been moving quickly to prohibit or to constrain them (though, as I recently observed, 2012 witnessed a few more "red light" states).  Consequently, it remains worthwhile to "battle to get recognition for futility policies."